Delirium

People with a terminal illness, especially just prior to deathPeople with a serious illnessThe elderlyCancer patientsAIDS patients People who are severely sleep deprivedPatients with a diagnosis of dementiaPatients in the immediate period after surgery Patients with: Burns Central nervous system problems (eg, strokes , seizures, or tumors) Patients (especially hospitalized patients) who are: Visually or hearing impairedImmobileDehydratedConstipatedMemory impairedDeficient in vitamins Symptoms Symptoms usually come on quickly. They can vary in severity, depending on the underlying cause. Symptoms can last for days, weeks, or longer. Symptoms are often worse at night. Symptoms of delirium can include: Inability to pay attentionConfusionMemory problemsLanguage disturbances Disorientation, especially in regard to: Time of dayWhere one isWho one isSevere symptoms include:Misinterpretationsfor example, thinking a doctor who is trying to help you is trying to hurt youIllusionsfor example, thinking someone is someone elseHallucinationsseeing, hearing, or feeling things that arent thereEmotional disturbancessuch as suddenly becoming very angry, fearful, or withdrawn for no apparent reason Diagnosis The doctor will ask about symptoms and medical history, and perform a thorough physical exam. The doctor will ask specific questions about:

Present injury or illnessUse of medications or illicit drugsTime when mental state changedHow and how fast the mental state changed There are many tests that may be used to help diagnose delirium. Depending on the specific case, any or all of these tests may be done, including: Blood electrolytesto measure levels of sodium, potassium, and calciumKidney and liver function testsBlood glucose levelsComplete blood count (CBC)Blood vitamin levelssuch as vitamin B12 and folateThyroid function testsBlood culturesto look for signs of infectionSpinal fluid cultureto look for signs of infectionUrine examination and cultureto look for signs of infectionArterial blood gasto check oxygen levels in the bloodToxicology testingto search for any illicit drugs in the bodyBlood levels of medicationsChest X-ray to look for signs of pneumonia Electrocardiogram (ECG, EKG)a test that records the heart's activity by measuring electrical currents through the heart muscle CT Scan a type of x-ray that uses a computer to make images of the inside of the head MRI a test that uses magnetic waves to make images in this case of the inside of the head Electroencephalogram (EEG)a test that record's the brain's activity by measuring electrical currents through the brain TreatmentDelirium is first treated by identifying and treating the underlying cause. Then, symptoms are treated through medications, psychologic management, and environmental and supportive intervention.

Treatments may include: Medication Drugs used to treat symptoms of delirium include: High potency antipsychotic medications such as HaldolBenzodiazepinesused to treat delirium caused by alcohol withdrawal or benzodiazepine withdrawalCholinergic medicationsused to treat delirium caused by anticholinergic medicationsVitaminsspecific vitamin supplements are given if the delirium is caused by a deficiencyIn addition, medications that might worsen confusion and are not essential to the patient may be stopped. Psychologic Management This type of therapy involves helping the patient to: Feel more safe and comfortableIdentify the cause of the deliriumImprove the ability to functionCalm down and feel less anxious Environmental and Supportive Intervention This type of treatment can be done by doctors, nurses, and/or caretakers of the patient. It is aimed at reorienting the patient to his or her surroundings and reducing the patients anxiety. It can involve actions such as: Placing a clock and calendar in the patients roomDarkening the room at night and providing natural light during the day time hoursMaintaining a quiet, noise-free roomReminding the patient often of the day and time, where they are, and why they are therePlacing familiar objects around the patient (eg, family photographs or objects from home) Prevention A number of steps have been shown to help prevent delirium in hospitalized patients at risk for delirium. These steps include:

Using memory orientation aidsListening to relaxation tapesDoing very light exercise (when possible and if recommended by your doctor)Using vision and hearing aids (when necessary)Drinking plenty of fluids (to prevent dehydration)Delirium is difficult to prevent because it has so many possible underlying causes and it comes on so suddenly. RESOURCES: American Association of Community Psychiatristshttp://www.comm.psych.pitt.edu American Psychiatric Associationhttp://www.psych.org National Institute of Mental Healthhttp://www.nimh.nih.gov CANADIAN RESOURCES: Canadian Psychiatric Associationhttp://www.cpa-apc.org/ Canadian Psychological Associationhttp://www.cpa.ca/cpasite/home.asp References: American Psychiatric Associationwebsite. Available at: http://www.psych.org. The Merck Manual of Medical Information . Simon and Schuster, Inc.; 2000. National Institutes of Mental Health website. Available at: http://www.nimh.nih.gov. Last reviewed November 2007 by Ryan Estvez, MD, PhD, MPHPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.